Provider Demographics
NPI:1912198094
Name:LORI A HARKINS MD PC
Entity Type:Organization
Organization Name:LORI A HARKINS MD PC
Other - Org Name:HARKINS EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-384-9148
Mailing Address - Street 1:830 N ALPHA ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4320
Mailing Address - Country:US
Mailing Address - Phone:308-384-9148
Mailing Address - Fax:308-384-9158
Practice Address - Street 1:830 N ALPHA ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4320
Practice Address - Country:US
Practice Address - Phone:308-384-9148
Practice Address - Fax:308-384-9158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03637OtherBLUE CROSS BLUE SHIELD
NE=========00Medicaid
NE03637OtherBLUE CROSS BLUE SHIELD
NE0173930001Medicare NSC
NE098400Medicare PIN